63例早发性卵巢功能不全患者病因及临床特点分析

发布时间：2019-06-07 17:38

【摘要】：目的:探讨导致早发性卵巢功能不全(POI)的高危因素及其临床特点,提高对POI的认识,为POI患者的早期诊断和预防提供理论依据。方法:调查收集2014年12月至2016年7月就诊于山西医科大学第一医院妇科门诊的63例POI患者的相关临床资料,收集内容如下:1、相关危险因素的相关结果,如:染色体核型;甲状腺功能五项;既往是否患有桥本氏甲状腺炎、甲状旁腺功能亢进、系统性红斑狼疮、肾上腺皮质功能不全等自身免疫性疾病;盆腔手术史;腮腺炎、结核、麻疹、水痘等感染史;主被动吸烟史;A型行为调查问卷等;2、临床资料:患者的年龄、职业、闭经前月经情况或月经不调的年限、孕产史等。分析POI患者的年龄分布情况,各危险因素的所占比例及临床特点。结果:1.63例POI患者中:年龄在17岁至40岁之间,平均年龄为26.59±6.29岁,≤30岁的患者49例,占77.78%。30岁的患者14例,占22.22%。2.63例POI患者中:染色体异常者9例占14.29%、自身免疫功能异常者3例占4.76%、医源性因素2例占3.17%、感染因素11例占17.46%、不良环境因素接触者39例占61.9%、A型行为者38例占60.32%、不明原因者7例占11.11%。3.63例POI患者中:原发闭经者10例占15.87%,月经稀发者15例占23.81%,继发闭经者38例占60.32%。继发闭经患者闭经前有35例表现为月经不调占55.56%,3例表现为规律月经后突发闭经占4.76%。10例原发闭经者中,染色体异常者6例占60%,不良环境因素接触者3例占30%,A型行为者3例占30%。15例月经稀发者中,染色体异常者1例占6.67%,不良环境因素接触者12例占80%,A型行为者10例占66.67%。38例继发闭经者中,染色体异常者2例占5.26%,不良环境因素接触者24例占63.16%,A型行为者25例占65.79%。4.63例POI患者中:既往曾妊娠者14例占22.22%,其中12例(85.71%)曾有不同次数的流产。结论:1.本研究显示POI在40岁之前的育龄期女性中平均发病年龄为26.59±6.29岁。2.POI病因复杂,临床上应早期进行多因素排查,及时进行干预并根据病因采取相应治疗。3.POI患者中:原发闭经者的主要危险因素是遗传因素;月经稀发者及继发闭经者的主要危险因素是不良环境因素及个人生活行为。4.POI患者多数在早期出现月经异常,仅少数表现为规律月经后突发闭经,在出现月经异常时应注意评估卵巢功能并进行生育力保存。
[Abstract]:Objective: to explore the high risk factors and clinical characteristics of (POI) leading to early ovarian insufficiency, to improve the understanding of POI, and to provide theoretical basis for early diagnosis and prevention of POI patients. Methods: the clinical data of 63 POI patients in the gynecological clinic of the first Hospital of Shanxi Medical University from December 2014 to July 2016 were investigated and collected as follows: 1. The related results of related risk factors, such as chromosome karyotype; Keywords 5 items of thyroid function, whether or not they suffered from autoimmune diseases such as Hashimoto's thyroiditis, hyperparathyrothyroidism, systemic lupus erythematosus, adrenocortical insufficiency, history of pelvic surgery, etc. History of mumps, tuberculosis, measles, varicella and other infections; history of active and passive smoking; type A behavior questionnaire, etc. 2, clinical data: patient's age, occupation, menstruation before menstruation or menstruation, history of pregnancy and delivery, etc. The age distribution, the proportion of risk factors and clinical characteristics of POI patients were analyzed. Results: 1. Among 63 patients with POI, there were 49 patients (77.78%) aged between 17 and 40 years old, with an average age of 26.59 卤6.29 years, accounting for 77.78%. 14 patients aged 30 years. Among 2.63 patients with POI, 9 cases (14.29%) had chromosome abnormalities, 3 cases (4.76%) had abnormal autoimmune function, 2 cases (3.17%) had iatrogenic factors, and 11 cases (17.46%) had infection factors. 39 cases (61.9%) were exposed to adverse environmental factors, 38 cases (60.32%) were type A actors, and 7 cases (11.11%) were unexplained. Among 3.63 patients with POI, 10 cases (15.87%) had primary atresia. There were 15 cases (23.81%) with sparse menstruation and 38 cases (60.32%) with secondary menorrhea. Among the patients with secondary atenorrhea, 35 cases showed irregular menstruation (55. 56%), 3 cases showed sudden menorrhea after regular menstruation (4. 76%), and 6 cases (60%) had chromosome abnormalities in 10 cases of primary atresia. 3 cases (30%) were exposed to adverse environmental factors, 3 cases (30%) were type A behavior, 1 case (6.67%) had chromosome abnormality and 12 cases (80%) were exposed to adverse environmental factors. There were 10 cases of type A actors (66.67%), 2 cases of chromosome abnormalities (5.26%) and 24 cases of exposure to adverse environmental factors (63.16%). Type A behavior was 25 cases (65.79%). Among 4.63 patients with POI, 14 cases (22.22%) had previous pregnancy, 12 cases (85.71%) had different miscarriages. Conclusion: 1. This study showed that the average age of onset of POI in women of childbearing age before 40 years old was 26.59 卤6.29 years old. 2.POI had complex etiology and should be investigated by multiple factors at an early stage. Timely intervention and corresponding treatment according to the etiology. 3. In POI patients, the main risk factor of primary atresia is genetic factor; The main risk factors for patients with rare menstruation and secondary atresia are adverse environmental factors and personal life behavior. 4. Most patients with POI have abnormal menstruation in the early stage, and only a few of them show sudden menorrhea after regular menstruation. In the event of abnormal menstruation, attention should be paid to the evaluation of ovarian function and fertility preservation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.75

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